In North Carolina, South Carolina and Georgia, Cooperative Extension Services, Land grant and state universities, and the Greenville (SC) Hospital System have formed a consortium to reduce cancer morbidity and mortality in their Appalachian counties. This effort is further supported by the State Health Departments (Cancer Control, Assist and Health Promotion programs), the American Cancer Society, and the Regional Cancer Information Service. Study Design: TSALIC is a multi-site, randomized, controlled community intervention trial. The goals are to: 1) decrease cancer incidence and mortality; 2) increase diagnosis of cancers at earlier stages; 3) prevent cancer incidence and mortality rate increases; 4) reduce the barriers and improve access to quality cancer services; and 5) stimulate participation in community cancer control outreach programs. The specific aims are to: 1) create a network of community cancer control coalitions throughout the Appalachian portions of the three states; 2) mobilize community lay and professional leaders for cancer control coalitions and outreach activities; 3) develop, disseminate and support effective cancer control intervention programs and strategies; 4) develop a volunteer cancer control system to supplement the efforts of paid TSALIC staff; 5) evaluate the effectiveness of this initiative; and 6) stimulate cancer control data collection and research. Evaluation: The evaluation protocol is designed to measure the extent to which the strategies for coalition building and cancer control are successful in effecting the desired changes in cancer related knowledge, attitudes and behaviors. This will include the collection of qualitative and quantitative data relating to educational experiences, community development strategies, targeted message adoption or development and program outcomes including self- reported participation in screening, lifestyle changes and, over time, changes in the incidence of common cancers.